Simulation-Based Learning In Healthcare Ethics Education
Creative Education, 2016, 7, 131-138Published Online January 2016 in SciRes. 0.4236/ce.2016.71013Simulation-Based Learning in HealthcareEthics EducationGul Pinar, Sibel PeksoyDepartment of Nursing, Faculty of Health Sciences, Yıldırım Beyazıt University, Bilkent, Ankara, TurkeyReceived 27 November 2015; accepted 25 January 2016; published 28 January 2016Copyright 2016 by authors and Scientific Research Publishing Inc.This work is licensed under the Creative Commons Attribution International License (CC tractEvery year, millions of people die or get seriously injured due to errors in health practices. Therefore, it is crucial that safe care is enabled and medical errors are minimized in nursing practicesand rapid response is given to changing health conditions. In order to train nurses who have professional values and are efficient in their field, simulation-based ethical education has becomepopular today. Enabling patient safety and preserving legal rights are ethical obligations in termsof personal, institutional and vocational benefit. Simulation is an educational model consisting ofethical and legal concepts. In this context, it is envisaged that simulation-based training such asself-rule, patient consent, patient defensiveness, empathy, communication skills and care in special patient groups are integrated in all health fields. It is considered that this approach regardedas an innovative practice can contribute to the training of health team, which has ethical values.The purpose of this study is to evaluate the current state of the simulation-based ethical trainingunder the light of literature review.KeywordsEthical and Legal Content, Nursing Education, Simulation, High-Fidelity Human Simulator1. IntroductionEvery year, tens of millions of patients worldwide suffer disabling injuries or death because of unsafe medicalpractices and care. According to World Health Organization (WHO), almost one in every ten patients is harmeddue to preventable causes in the hospital settings (WHO, 2013). It is indicated in 1999 report of the Institute ofMedicine (IOM) that every year approximately 44,000 to 98,000 persons die due to errors originating fromhealth practices. In this report, it is emphasized that the number of preventable deaths due to health practices ismore than the number of deaths caused by motorized vehicle accidents, breast cancer and AIDS (Kohn & CorHow to cite this paper: Pinar, G., & Peksoy, S. (2016). Simulation-Based Learning in Healthcare Ethics Education. CreativeEducation, 7, 131-138. http://dx.doi.org/10.4236/ce.2016.71013
G. Pinar, S. Peksoyrigan, 1999). These findings reveal that medical errors are a threat element in enabling patient safety.In the current list of the Economic Cycle Research Institute (ECRI) (2015) on patient safety, significant problems are cited such as informatics systems, violence management, surgical practices, medicinal practices, patientcare, discharge, patient admission and transport (ECRI, 2015). Most of these problems occur because of errorsbased on communication process. The Joint Commission (TJC) emphasizes that 70% of sentinel events takeplace based on insufficient communication (Rosenstein & O’Daniel, 2008). Therefore, in order to enable patientsafety, some national and international institutions care about the professional competence of health professionals. The National League for Nursing (NLN) defines main competencies, as nursing skills need to be “patientcentered care and the validation of practice competence crucial for patient safety and quality of care” (NLN,2010). The IOM indicates in its report that providing high quality and safe care in professional practices needadvanced level of skillful and efficient professionals to respond to changing health conditions swiftly. The IOMsuggests that simulation is used in the training of health professionals to improve professional competency(Kohn & Corrigan, 1999). In this context, the Association of Simulation in Health (ASH) was founded in 2004in the United States to improve patient safety by using simulation techniques (Galloway, 2009). Furthermore,ethical matters started to be considered in the ethical laboratories in Belgium in 2008 as integrated to the simulation training for the first time (Vanlaere et al., 2012).Simulation provides a level of competence prior to actual patient care from low tech to high tech, which isone method to train health professionals (Hallenbeck, 2012; Göriş et al., 2014). This method can be delivered invarious classrooms, clinical and virtual setting based on the goals of the simulation. That training is not simplytechnical. Because it has become standard practice to train clinical skills using high tech computer, scenario,mannequins, low and high fidelity patient simulators, virtual reality, haptic devices, live actor or standardizedpatients (Göriş et al., 2014). Simulation activities need to ensure patient safety without danger of harming thepatient during the learning process (Galloway, 2009). Clinical practice is essential to nursing, and in its shadowis the theory and research that are needed to advance the science of nursing and improve its clinical application.Faculty needed a dynamic learning activity to help students to recognize the importance of legal and ethical aspects of nursing care.The practices of simulation also provide to confront ethical challenges with patient safety in healthcare.Hence, the health care authorities allow students to perform all medical procedures and practices on clients withsimulated practices in various clinical situations instead of actual patient. The ethical approach believes that variances in culture and society influence whether an act is moral (ANA, 2015a). Simulation training assists determine ethical problems that relate to principles of autonomy, beneficence, justice, informed consent, nonmaleficence, fairness, truthfulness, advocacy, and dedication (Haddad, 2010; Vanlaere et al., 2010; Hallenbeck, 2012;Smith et al., 2012; Vanlaere et al., 2012; Smith et al., 2013). Therefore, the ethics of simulation should be discussed within the context of the larger healthcare systems. Despite the growing popularity of clinical simulationto improve quality and safety in healthcare education, the question of whether students actually transfer the ethical values that takes place in a simulation setting is unknown.AimIn the present study, the evaluation of the current state of simulation-based ethical training was aimed under thelight of literature review. This study focused on some of the general issues in ethics and legal of simulation.Ethical considerations contribute to the understanding of effective learning methods and provide guidance tofaculty using simulation technology such as cultural barriers, medico legal concerns, and logistics.2. The Ethics of SimulationProfessionalism and professional values is one of basic elements for quality nursing education (AmericanNurses Association (ANA), 2015b). The content consists of values, ethics, legal concepts, professionalism, andculture, and holds graduates to the values of altruism, autonomy, human dignity, integrity, and social justice(Shahriari et al., 2013; ANA, 2015b). It is expected that nursing graduates will uphold legal and ethical professional standards in their own practice and prevent illegal and unethical care.Simulation based on three ethical imperatives; keep patients safe, prevent errors and facilitate engaged learning. The simulation environment needs to be one that promotes trust and safety. Simulation leads to better-educated students who developed a more humanistic care towards patients. Simulation scenario is critical in132
G. Pinar, S. Peksoythe preparation of clinicians prior to that first actual patient experience including collaboration through teamtraining, inter professional, critical thinking, and independent decision-making skills (Bridges et al., 2011; Aebersold& Tschannen, 2013). The vital component in these scenarios is the prebriefing and debriefing. Especially, effective feedback and debriefing after the simulation can be provide the opportunity to learn in the safety climateand as well as ethical knowledge gaps (Smith et al., 2012). Faculty became concerned that students were failingto realize the value of legal and ethical concepts as applicable to clinical practice.Anglo-American healthcare ethics are marked by attention to questions of patient autonomy and choice. Infact, a recent study shows that the frequency of moral distress among nurses, arising from unresolved ethical issues, negatively correlates with the quality of nursing care (DeKeyser Ganz & Berkovitz, 2012). Hence, theseconditions culminated in a growing support for the role, management, and integration of ethics quality inhealthcare. A Code of Ethics is one way to embed ethics quality in nursing (ANA, 2015b). The Nurses’ Code ofEthics consists of normative elements, guiding the conduct and ethical decision making of nurses.2.1. Ethical Principles and TheoriesEthical principles and ethical theories that are used in health practices frequently will be discussed in this section.Basic of ethic principles consist of autonomy, beneficence, nonmaleficence, fidelity, and justice (see Figure 1).2.1.1. Ethical PrinciplesAutonomy: This principle is an agreement to respect another’s right to self-determine a course of action andsupport of independent decision making (ANA, 2015a). Informed consent is evaluated in the context of autonomy principle. Nurses should provide the required information in health care practices and they shall receive informed consents (Burkhardt & Nathaniel, 2013). Receiving approval of the individuals in every practice is anethical obligation. Nurses have responsibility to protect patients’ freedom of choice. Patient should get all theinformation (accurate and true) about difficulties of treatment, during her treatment process, succes of treatmentprocess and quality of life after recovery. Every clinical desicion should: Not only have reliable and up-to-date medical information but should have ethical information, It must be allowed to the patients that they can make their own desicions, Desicions must be patients’ own, The patients must not be concerned themselves about make a desicion, And also they must not feel themselves under pressure.Beneficence: The basis for this principle is based on the patient advocacy using compassion, taking positiveaction to help others, and desire to do good in nursing ethics (ANA, 2015a). Beneficence refers to moral obligation to act the benefit the others. The desicion that made by up-to-date and reliable information should gainmedical benefit. The aims of the beneficence principle make up the justifications of nursery practices. Nursesshould evaluate the possible harms and well-being of served individuals in the case of non-ethical act and insufficient care. In a practice that develops unethically, they should act properly for patient advocacy (Burkhardt &Nathaniel, 2013).Nonmaleficence: This principle that describes avoidance of harm or hurt within medical oath and nursingethics (ANA, 2015a). It is related to beneficence principle. In this principle, injury risk is evaluated during male-Figure 1. Ethical Principles. Resource: American Nurses Association (2015a). Code of ethics for nurses withinterpretive statements. URL (last checked 15 November f.133
G. Pinar, S. Peksoyficence, harm risk and benefiting. For instance; unnecessary medical interventions made only for gaining experience are included in this scope (Burkhardt & Nathaniel, 2013).Fidelity: This principle refers keep a promises, based upon the virtue of caring. Fidelity requires loyalty,fairness, truthfulness, advocacy, and dedication to patients (ANA, 2015a). Fidelity is considered as a universalmerit. Honesty and not to lie is among the ethical liabilities. Nevertheless, there are some practices that couldviolate this principle. Administering placebo medication and withholding information about illnesses that gobadly can be given as examples in this scope (Burkhardt & Nathaniel, 2013).Justice: This principle means an equal and fair distribution of resources, which is relied on analysis of benefits and burdens of decision. This principle also refers that all citizens have an equal right to the goods distributed, irrespective of what they have contributed or who they are (ANA, 2015a). It is an ethical principle used inthe development of health policies and reaching decisions at the institutional level. It aids nurses how the limitedresource is used most properly in patient necessities. For instance; for whom the intensive care beds will be assigned and what type of patients will be admitted to the emergency service is considered in this scope (Burkhardt & Nathaniel, 2013). Justice is guide when medical resources are limited especially sharing treatmentresources between patients such as cancer treatments (inadequate and expesive).2.1.2. Ethical TheoriesDeontology and utilitarian theory is benefited for reaching ethical decisions in health care practices.Utilitarianism: This theory that supports what is best for most people. The value of the act is determined byits usefulness, therefore this theory is focused on the outcome or consequences. This theory appears to give advantege to the majority population. Utilitarianism makes research what creates the most happiness for the mostpeople. Most of countries in the health policies are based upon this principle, all over the world (ANA, 2015a).Deontology: This theory judges the morality of an action based on the action’s adherence to rules. Whetheran action is right or wrong does not depends on its outcomes. Deontology is based on the work of ImmanuelKant. According to this theory, all individual actions should be done, as if they could become universal law(ANA, 2015a).The primary liability in terms of ethical angle according to the ANA; is indicated as to preserve health, enablepatient safety and protect legal rights (ANA, 2015c). Ethical practices provide benefit in terms of both vocational and institutional points. Therefore, they consist of provisions binding health workers and bring along someethical obligations. Ethics make up one of the basic elements of professional training in terms of vocational angle. Professional ethics enable raising of professionals who have professionalism and vocational values. Nursesare trained as professionals who provide humanistic care in this context.In the simulation setting, the educator can manipulate the environment and control the scenario so that learners can practice responses to significant events. In the case of simulated ethic problems, such control is essentialto maximize benefits for the learner. Students must balance their ethical responsibilities with those of satisfyingstakeholders and reflect complex situations with incomplete information. Students also commented on what theylearned by completing the simulation during debrefing.3. The Challenges of Simulation for Ethical IssuesSimulation model is being used today in a variety of health care programs designed to enhance the clinical skillswithout danger of harming the patient (Galloway, 2009). Research on the use of simulation in nursing educationindicates faculty and students like the strategy (Nehring & Lashley, 2009), but statistical evaluation of the efficacy of simulation is difficult, particularly in relation to its association with individual performance in the actualclinical setting. Whether simulation is used as a teaching strategy or a method of evaluation, the use of simulation to enhance clinical teaching in nursing education may increase personal confidence in clinical performance(Galloway, 2009), but the influence of simulation on competence in clinical judgment and ethical values in practice is unknown. The simulation method provides a way for instructors to demonstrate the top of Miller’s pyramid performing the skills in the realistic environment (Munshi et al., 2015).The educators should respect the dignity of all participants. There are questions specific to management, education, research, the use of technology, registration, medical records, and even the types of simulations (Aggarwalet al., 2010). Simulation-based education has caused various challenges to teachers, students, managers, and patients. In addition to these challenges, ethic education also is a fundamental challenge at the simulation-based134
G. Pinar, S. Peksoylearning. Ethic education is consisted of the protection of the ethical well-being, the preservation of values andcultural heritage of societies is a major concern of educational system (Aslani et al., 2013). Clinicians receivelittle training in dealing with death, dying and end of life issues in simulation-based education. The biggest concern about allowing the mannequin to die is the psychological safety of the students. There is discussion withinthe simulation team about allowing death of the simulated patient to be part of scenario.4. Evidence-Based Studies for the Ethics of SimulationThe problems that occur during patient care by nurses (Vanlaere et al., 2010; Vanlaere et al., 2012), communication-based conflicts (Haddad, 2010; Torrance et al., 2012) and value conflicts (Smith et al., 2012) startedto stand out gradually. In this scope, ethical perspective took its place in simulation-based education especiallyduring the past 10 years. Although the studies carried out in this field are limited, usage of technological developments in ethical training is in search of solution about the ethical curriculum arrangement, consideration ofhumans as a whole with their values, how care that is given to vulnerable/fragile groups gains more importance,how the communication reacts in hard processes and how the scenarios specially fictionalized for this processare to be developed (Haddad, 2010; Vanlaere et al., 2010; Hallenbeck, 2012; Smith et al., 2012; Vanlaere et al.,2012; Smith et al., 2013). Health professional and educators focus on the insufficiencies in reporting of healthpractices, problems about communication process, lack of team work, and insufficiency of critical thinking skill(JCAHO, 2005). Therefore, ethical matters have been structured as focused on patient care and safety process.In simulation-based ethical education, current matters such as empathy, fragile patient groups, informed consent,communication skills and giving bad news are included (see Figure 2) (Haddad, 2010; Vanlaere et al., 2010;Smith et al., 2012; Vanlaere et al., 2012; Torrance et al., 2012; Chen, 2011).Dilemmas and conflicts occurring during simulation-based ethical training are experienced by students/healthprofessionals. Preparation is key to a successful simulation program. At the start of the simulation, it is important to set expectations with the students. The simulation team debriefs about their performance and whatchanges should be focused for the future experiences. Especially, inter professional simulations, team work andcommunication are essential components of ethical issues. The Inter professional Education Collaborative Expert Panel-IECEP (2011) devoted one of the four domains to values/ethics for inter professional practice. In thestudy of Smith et al. (2012), crises were generated within the simulation scenario content and breakage pointswere formed in the conflict process. The students were asked to state their decisions and to analyze their decisions primarily in the solutions following scenario application. Moreover, specific questions for the scenariopurpose, the effect of different cultures on the disease and what should be considered in the future are discussed.During the debriefing process, s
Nov 15, 2015 · Faculty needed a dynamic learning activity to help students recognize the ito mportance of legal and ethical as-pects of nursing care. The practices of simulation also provide to confr
1 Simulation Modeling 1 2 Generating Randomness in Simulation 17 3 Spreadsheet Simulation 63 4 Introduction to Simulation in Arena 97 5 Basic Process Modeling 163 6 Modeling Randomness in Simulation 233 7 Analyzing Simulation Output 299 8 Modeling Queuing and Inventory Systems 393 9 Entity Movement and Material-Handling Constructs 489
I Introduction to Discrete-Event System Simulation 19 1 Introduction to Simulation 21 1.1 When Simulation Is the Appropriate Tool 22 1.2 When Simulation Is Not Appropriate 22 1.3 Advantages and Disadvantages of Simulation 23 1.4 Areas of Application 25 1.5 Some Recent Applications of Simulation
The Healthcare Simulation Dictionary is the intellectual property of The Society for Simulation in Healthcare (SSH). The Agency for Healthcare Research and Quality
makers in healthcare management. 2 / 2022 Media Kit / ache.org The American College of Healthcare Executives is an international professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organizations. Healthcare Executive e-TOC Published bimonthly, e-TOC is a
Simulation Project Success and Failure: Survey Findings. Simulation and Gaming, 33(1), 49-66. Ruben, B. (1999). Simulations, games, and experience-based learning: The quest for a new paradigm for teaching and learning. Simulation & Gaming, 30, 498-505. Nursing Cant RP, Cooper SJ. Simulation-based
n Simulation and embedded system design ufunctional simulation uperformance simulation ŁPOLIS implementation Łpartitioning example uimplementation simulation Łsoftware-oriented Łhardware-centric n Summary Cycle-based, logic simul. Design flow Behavior capture Mapping (partitioning) Architecture capture Functional simul. Architecture simul .
Simulation Results and Analysis . We set the power frequency to 60 Hz and 100 Hz, respectively. . simulation experiments and research, based on the Matlab/Simulink simulation tool, the simulation model of the three-phase . Simulation Design of Variable Frequency Speed Regulating System for Automobile Remanufactured Generator Test Bench .
Simulation Models and Analyses Reference Version (v1.6) Apr 21, 2008 1 This reference details the simulation models and circuit simulation analyses and describes some simulation troubleshooting techniques. Simulation Models The Altium Designer-based Circuit Simulator is a true mixed-signal simulator, meaning
